Difference between revisions of "Congenital heart diasease"

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'''Repair of Levo TGA (Atrioventricular and Ventriculoarterial discordance aka Congenitally corrected TGA)'''
 
'''Repair of Levo TGA (Atrioventricular and Ventriculoarterial discordance aka Congenitally corrected TGA)'''
 
*Systemic blood enters RA, morphologic LV, then PA   
 
*Systemic blood enters RA, morphologic LV, then PA   
*PV to LA, morphologic RA, then aorta
+
*PV to LA, morphologic RV, then aorta
 
*Circulation is "correct" but RV and tricuspid valve (valve always concordant with ventricle) is systemic valve
 
*Circulation is "correct" but RV and tricuspid valve (valve always concordant with ventricle) is systemic valve
*Patients must undergo double swith of Mustard or Senning and Jantene
 
  
  

Latest revision as of 12:55, 20 January 2012

Cyanotic


Non-cyanotic


Palliative Procedures prior to Complete Repair

Modified Blalock Taussig Shunt

  • Graft between subclavian artery and ipsilateral pulmonary artery
  • Provides pulmonary blood flow to lungs in cyanotic CHD (single ventricle)
  • Complications include thrombosis and post operative seroma


Waterston Shunt - anastomosis between ascending aorta and right PA (not currently used)


Potts Shunt - anastomosis between descending aorta and left PA (not currently used)


PA Banding

  • Restricts pulmonary blood flow and increases systemic flow in VSD
  • Protects lungs from lasting effects of pHTN
  • Can also be used before repair of TGA to "train" the left ventricle for systemic pressures


Bidirectional Glenn

  • SVC anastamosed to right PA with flow into both PA
  • Used in patients 3-9 months old (after pulmonary pressure drops) as bridge to Fontan at age 2-4 years


Complex Repairs

Fontan

  • Completes the BDG by directing flow from IVC into PA
  • Initially for tricuspid atresia, now used for many single ventricle CHD


Norwood

  • Primarily for hypoplastic left heart syndrome (often a majority of systemic supply via PDA due to aortic coarctation)
  • Stage 1 - within first few days of life
    • Connect RV with systemic arterial circulation using main PA to reconstruct often stenotic aorta
    • Atrial septectomy to allow venous return to RV
    • Ligate PDA
    • BT (subclavian artery to PA) or Sano (RV to PA) shunt
  • Stage 2 - eliminate BT shunt and perform BDG (SVC anastamosed to right PA)
  • Stage 3 - Fontan


Repair of Dextro TGA (Ventriculoarterial discordance)

  • Initially a atrial septostomy to allow mixing of parallel circulations
  • Mustard or Senning procedures rerouted blood at atrial level with conduit to correct ventricle (not currently performed)
  • Jantene arterial switch can now be perfomred within first 2 weeks of life


Repair of Levo TGA (Atrioventricular and Ventriculoarterial discordance aka Congenitally corrected TGA)

  • Systemic blood enters RA, morphologic LV, then PA
  • PV to LA, morphologic RV, then aorta
  • Circulation is "correct" but RV and tricuspid valve (valve always concordant with ventricle) is systemic valve


Links